Effectiveness of haloperidol-promethazine versus haloperidol diazepam on rapid tranquilization of acutely agitated patients at Mirembe mental health hospital: a randomized control trial
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Date
2022
Authors
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Journal ISSN
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Publisher
The University of Dodoma
Abstract
Acute agitation is a common encounter in psychiatry and form part of emergency care in psychiatric settings. Wide range of injectable medications are often used in such situations and outcome effects are varied. Goal of care is to use agents that have fast onset of action, minimal side effects and less sedation. Thus, this study aims to compare effectiveness of haloperidol plus diazepam against haloperidol plus promethazine combinations in tranquilization of acute agitated patients. Eighty-six of86 patients with symptoms of agitation were randomly assigned under single-blinded conditions to receive either haloperidol either with promethazine or diazepam. ITT analysis was done using SPSS. Demographic and clinical characteristics were compared and analyzed using unpaired independent t- test for continuous variables and Chi-square test for categorical variables. PANSS-EC score and RSS score were used to assess levels of agitation and sedation at 15, 30, 60 and 120minutes after the first dose. Additional medications and side effect profile were also assessed at 120minutes, 24hours and 72hours. Both groups of medication show effectiveness in improving levels of agitation after first injection. Haloperidol - diazepam group had a fast onset of action at 15minutes and lower PANSS-EC scores both at 15 and 30minutes (P=0.0002; P=0.0017); while differences in mean scores were not significant at 60 and 120 minutes. Haloperidol - diazepam group hadsignificant sedation effect to patients 3.92 (SD=1.38) compared to haloperidol plus promethazine group 2.85 (SD=1.26). At 24 and 72 hours, haloperidol - diazepam group had more added injection compared to haloperidol - promethazine group. There were more patients who were either drowsy or stuporous and few unresponsive at 15,30 and 60minutes in haloperidol - diazepam group compared to haloperidol - promethazine group which had more patients either alert or drowsy and few stupors. Both combination agents are effective in reducing agitation. However, Haloperidol – Diazepam had more rapid onset of action with more sedating effect compared to haloperidol – promethazine which had slightly slower onset, prolonged effect and less sedating effect. Guidelines recommend use of medications with rapid action, prolonged effect and less sedating and adverse effects. In this case haloperidol-promethazine appear to be superior compared to haloperidol-diazepam.
Description
MMED Psychiatry
Keywords
Acute agitation, Haloperidol-promethazine, Haloperidol diazepam, Mirembe mental health hospital, Agitation, Antipsychotics
Citation
Mwankemwa, S. (2022). Effectiveness of haloperidol-promethazine versus haloperidol diazepam on rapid tranquilization of acutely agitated patients at Mirembe mental health hospital: a randomized control trial (Master dissertation). The University od Dodoma, Dodoma.